Annual Report 2014: How severe is it?

The 2014 Annual Report of the National Trauma Data Bank® (NTDB®) offers an updated analysis of the largest aggregation of U.S. and Canadian trauma registry data ever assembled. The NTDB now contains more than 6 million records. The 2014 Annual Report is based on 814,663 records with valid trauma diagnoses from the single admission year of 2013. The data were submitted by 758 facilities, including 230 Level I trauma centers, 265 Level II trauma centers, and 205 Level III or IV trauma centers; 32 are Level I or Level II pediatric-only centers.

Continuous quality improvements

Each year, the NTDB has increased the requirements for the submission of quality data. This data quality effort started in earnest with the introduction of the National Trauma Data Standard (NTDS) in 2007, which was the basis of the first single admission year Annual Report of 2008. Along with this increase in data quality, over the last seven years, the number of records submitted by the nation’s hospitals has increased by more than 160 percent. The 2008 Annual Report was the first to use the NTDS, and 506,452 records were submitted at that time. This year’s report includes 814,663 records.

One section in each of these annual reports outlines the Injury Severity Score (ISS), a numeric scale for stratifying injury severity. These scores are based on documented diagnoses in the medical record. The ISS scores range from one to 75, with the risk of death increasing as the score increases. This report categorizes an ISS of one to eight as minor; nine to 15 as moderate; 16 to 24 as severe; and greater than 24 as very severe. Almost half of the patients (47.6 percent) fall into the minor category, with approximately one-third (31 percent) categorized as moderate. The case fatality rate rises with increasing ISS, with the most severe group experiencing a case fatality rate of almost 30 percent (see Figures 1 and 2).

Figure 1. Incidents by ISS

Figure 2. Case fatality rate by ISS

Commitment to excellence

The mission of the American College of Surgeons (ACS) Committee on Trauma (COT) is to develop and implement meaningful programs for trauma care. In keeping with this objective, the NTDB is committed to being the principal national repository for data from trauma center registries. The purpose of the Annual Report is to inform the medical community, the public, and policymakers about a variety of issues that characterize the current state of care for injured persons in the U.S. It has implications in many areas, including epidemiology, injury control, research, education, acute care, and resource allocation.

Many dedicated individuals on the ACS COT, as well as at trauma centers throughout the U.S., contributed both to the early development of the NTDB and its rapid growth in recent years. Building on these achievements, the goals in the coming years include improving data quality, updating analytic methods, and enabling hospital administrators and quality leaders to compare outcomes. These efforts will be reflected in future NTDB reports to participating hospitals, as well as in the Annual Reports.

Throughout the year, we will be highlighting these data through brief reports that will be published monthly in the Bulletin. The National Trauma Data Bank Annual Report 2014 is available on the ACS website as a PDF file at www.ntdb.org. In addition, information is available on our website about how to obtain NTDB data for more detailed study. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDBatmneal@facs.org.